Dr. Beth: Postpartum Depression – The Facts & Your Future

After giving birth, about 75% of women experience postpartum effects on their mood, including feelings of sadness, anxiety, or imbalanced emotions. Many new moms deal with these  difficulties to a mild degree. The changes may be confusing and distressing, but the symptoms usually resolve themselves over a couple of weeks and generally the way you function isn’t greatly affected.  However, for somewhere between 11% to 42% of new mothers around the world, the process is not so simple. If the symptoms become severe enough to interfere with your ability to carry out tasks at home or at work, maintain relationships with people in your life, or affect your physical health, you are likely dealing with postpartum depression.

According to DSM-5, the diagnostic handbook used by mental health professionals, postpartum depression (PPD) is diagnosed as “depressive disorder with permpartum onset.” Permpartum onset is defined as starting anytime during pregnancy or within the four weeks following delivery or the end of a pregnancy. However, most professionals will continue to diagnose postpartum depression for up to a year following the child being born. PPD can also occur in women who have suffered a miscarriage or had an abortion.

The specific criteria required for the diagnosis of postpartum depression are the same as any other episode of depression. It consists of at least five of the following symptoms for two weeks or more:

  • Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others
  • Loss of interest or pleasure in activities
  • Weight loss or decreased appetite
  • Changes in sleep patterns
  • Feelings of restlessness
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Loss of concentration or increased indecisiveness
  • Recurrent thoughts of death, with or without plans of suicide

These symptoms can present in certain ways for women who have just given birth. Mothers with PPD can feel extremely overwhelmed by the idea of being a mother, or wonder if they should have become a mother in the first place. Guilt can result from the belief that one should be handling new motherhood better, often linked to a feeling like their baby deserves a more competent mother. Some mothers with PPD reported feeling like the baby would be better off without them.

Mothers with PPD often don’t feel bonded to their baby. They may feel resentment towards the baby, or their partner, or friends who don’t have babies.  Many new mothers with PPD report feeling empty or numb. They do not feel invested in their child and instead are just “going through the motions” of being a mother. There might be thoughts of running away and leaving their family behind.

These feelings are then exacerbated when new mothers are made to feel weak or defective for facing these challenges. There is the perception in society that new motherhood is a time of joy and excitement. If moms aren’t feeling that, they can feel like something in them must be broken. Watching other mothers who do not appear to be struggling may make those dealing with the symptoms above feel like a failure. Moms may be afraid that if they reach out for help people will judge them, or even that their baby will be taken away.

Most moms with postpartum depression will fully recover, especially if the illness is diagnosed and treated early. Research has shown that the longer someone waits to get help, the longer it will take for her to get better. Furthermore, the more effective the treatment is, the better result. There are certain steps you can take to ensure that the help you receive is as effective as possible.

Therapy is a hugely beneficial treatment for all types of depression, including that related to carrying and birthing a child. It is important to start therapy with the perspective that you know yourself, your symptoms, and your body better than anyone else. When first beginning therapy, be honest with your them about what is working and what is not. Tell your therapist about what you are feeling and if you think treatment is working. Keep them posted on what symptoms continue and which ones are improving or have resolved. If anything new arises, don’t think that this will be a disappointment to your therapist or anyone involved in your recovery. Therapy is not a straight line, and symptoms can have their ups and downs. The more you share, the more effectively your therapist can help you. And if your therapist does not seem to be a match for you, it is okay to try a variety of professionals to find one that fits.

Medications can also be a viable option for mothers dealing with Postpartum Depression. Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating for PPD symptoms. However, it should be noted that the quality of the evidence is low given it is based on very few studies and patients. It remains unclear which antidepressants are most effective for treatment of PPD and for whom they are most advisable. For many women, therapy works without the addition of medication. But if you are not improving, there is nothing wrong  with exploring the option of a prescription to help you though the tough times.

While professional help in the form of therapy or medications can be crucial to one’s recovery, building a support system for our daily lives is as well. Figure out the people in your life that you can count on when you are feeling alone or hopeless. Let these family members or friends know what you are going through. Talk with them about how you are feeling and ways they can help. You may be able to find a local support group to attend, or an online community of mother going through similar struggles. Many are free to join and maintain the privacy of their members. In general, keep supportive people close and take some distance from anyone making you feel worse about your situation.

Remember that you will only improve and start to feel better once you invest in your recovery. You have to open up to your therapist, try techniques they recommend, take medications as prescribed, and reach out to your support system. Try to sleep as regularly as possible, ask for help when you need it, and maintain good nutrition. And don’t stop these steps as soon as you start to feel better! Talk with your mental health providers and those who know you best to determine how to keep your progress steady and lasting.

Dr. Beth Rutkowski is the Lead Psychologist at Olivia’s Place in Shanghai. If you have questions or concerns about your mental health or that of loved ones, you are welcome to contact her directly at ber@lih-oliviasplace.com or the Olivia’s Place team at (8621) 5404-0058.


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